Suffering In Secret

Eating disorders are commonly seen as affecting only women, but they affect all genders. The number of men being diagnosed with food-related mental illnesses is increasing — yet many more go undiagnosed and untreated. One man, a college student, shares his story of battling a disorder for half his life.

Former South Eugene High School tennis standout Eric Richers, 26, has struggled with an eating disorder for half his life. Photo Credit Andy Abeyta

On a Friday evening in May, 26-year-old Eric Richers intentionally ignored everything he had learned during five weeks of intensive treatment. Having spent the day helping his parents move offices, he had worked up a ravenous appetite. Once home, alone in his bedroom, he ate a generous helping of leftover Thai food—more than he needed or wanted to.

A familiar sensation came over him: fullness. Then: guilt. Shame. He knew what was coming. He went to the bathroom and glanced at himself in the mirror. He bent over the toilet, tensed his abdominals, forced open his throat with practiced ease, and vomited.

That’s how bulimia nervosa usually manifests: first binge, then purge. For years, Eric would plan his binges before he purged: set up his food, isolate himself, and eat excessively, knowing he would soon rid his body of it.

The person in the mirror had a striking face, equal parts German and Mexican, with a sharp jaw, mahogany eyes and coal-black hair. At 5’7″ and 150 pounds, he is built like an ant: small yet strong, with a lean musculature carried over from his days as a high school tennis star. But whereas many in his hometown of Eugene, Oregon, known as “Tracktown USA,” might praise his athletic physique, Eric saw a body of flaws.

When he was younger, he used to shove a finger down his throat to induce vomiting. Now, he says, “I just can make myself.”

While bulimia and anorexia have become commonplace ideas, the issue historically focused on females, and only recently have other genders entered the discussion. Past research showed that one in ten people diagnosed with an eating disorder was male. According to more recent estimates, that number has risen to at least one in four—a 250-percent increase. Yet men may exhibit different symptoms, meaning that red flags can be overlooked, and diagnosing can be problematic. As a result, many males suffer in silence.

In March, Eric began treatment at the Eating Disorder Center of Eugene (EDCE), one of two male patients at the facility.

For Eric, overcoming an illness that had gone unchecked for half his life would be no quick-and-easy task. Inside his mind, two opposing forces have been waging a constant tug-of-war for control: his “healthy self” versus his “eating disorder.”

To most people, the disorder he’s battled for over a decade has been all but invisible.

A life lived in secret

A week has passed since the last purge. In a bedroom of a one-story house in West Eugene, a 20-minute drive from his childhood home, Eric sits on his bed leafing through old photos. He’s paused at one taken roughly fifteen years earlier: little Eric standing by first base, mitt hanging loose, wearing a red jersey that clings to a bit of fat in his midsection.

“I’m kind of jealous of this kid right here,” Eric says. “I don’t think he really cared that he was fat at that point.” His brow knits together. “Is that even fat? I don’t even know—my perspective is skewed.” It was soon after this time, he guesses, that he started to become self-conscious of his physique.

Eric curls into the fetal position on his bed, recalling the decisive moments in his childhood that he now understands were red flags, signals of his disorder.

“All of a sudden I was the ugliest person in the room.”

Elementary School. Eric had been slightly overweight for several years. But when Eric was about 10, his mother, Esther, began to notice changes in his habits. Little Eric had made a deliberate decision to stop ingesting processed sugar. “There was a night that ice cream was offered and Eric said ‘No,'” she recalls. He always ate ice cream. He had also started drinking only water, though “he always drank juice.” A petite woman with black hair and dark eyes, Esther wears a gold necklace with a tennis racket pendant.

Sixth grade. Eric asked to play basketball with another boy. “He was like, ‘You can’t play, man. You’re fat.’ And I cried. It hurt me so bad.” He decided to lose weight.

Eric took up tennis. He started secretly putting tape on his nipples to reduce the appearance of fat on his chest. He wore two shirts to conceal the tape. Like many such efforts, there were two distinct parts: taping to look thinner, two shirts to hide the alteration.

Early high school. Dieting and exercise were no longer enough. Eric purged for the first time. His mother was relieved that the baby fat seemed to have melted away. Others noticed too. His tennis game improved. Coaches praised him; he praised himself. “I grew addicted to the high of the confidence and the attention,” he says. “I would get high just looking in the mirror at myself.”

Late high school. A straight-A student and star athlete at South Eugene High School, he rose to be a regionally ranked tennis player. Eric worked fervently towards a body that any young man might want: one that was lean, muscular, and cut. A magazine cover, featuring Brad Pitt, hung in his sister’s bedroom as a photographic manifesto of what Eric wanted for himself: rippled arms, defined pectorals, chiseled abdominals, and not an ounce of fat anywhere.

Working out became an obsession. He would do arm and leg workouts at 5 a.m. at a local gym, play tennis by himself during lunch, and then practice with his team after school. He starved himself, eating less than his body needed to maintain his activity, a behavior called “restricting.” He would periodically binge as a result of being underfed — only to vomit later. Hardly anyone questioned his behaviors; many saw his efforts as dedication to his sport.

In a way, it was all for the praise. For his girlfriend Mandy’s appreciation of his body. “I don’t want a six-pack and look this certain way just for me,” he says. Looking like Brad Pitt isn’t about just having a lean body — it’s also about what women think of that body. “If I’m hot,” his disorder tells him, “then I can get validation from women.” The irony was that Eric’s secrecy and deception kept him at arm’s length from those he cared about.

His thoughts were often hijacked by the disorder, and Healthy Eric was often overpowered. He could not perceive his body clearly. So much rested on the tiniest detail. A compliment would lift him up, but a perceived flaw would soon put him back down. “All of a sudden I was the ugliest person in the room,” he says. His mind switch-backed between being ultra-confident and ultra-dissatisfied.

During Eric’s last years of high school, Esther began to suspect her son was purging. She had him examined by a doctor, who referred him to a nutritionist. Eric denied his behaviors, Esther says, and neither professional diagnosed him. “My impression was they thought, ‘This is a very worrisome mother just hovering over this child,'” she says. “I felt pretty much ignored. The problem was ignored.”

Undiagnosed and out of control

“The fact that binge eating or exercising or dieting don’t call as much attention when men do it, I think, doesn’t mean it happens less,” says Jason Roberts, a marriage and family therapist at EDCE who specializes in eating disorders. “It’s just that it more easily goes under the radar.

As per patient confidentiality, Roberts refused to discuss specifics of any individual case or patient, including Eric, but was willing to share in general terms his knowledge of eating disorders among men. Roberts, who has also recovered from an eating disorder, says the treatment process was originally designed “by females for females.”

For example, one questionnaire used for evaluating patients is based on the norms of a typical college female, with questions about amenorrhea, a loss of menstrual periods, and a desire to be thin. Eating disorders in men, however, often manifest not as a drive for thinness but for leanness and musculature. So someone like Eric could take the questionnaire and pass as normal.

“I didn’t know I had an eating disorder when I had an eating disorder,” Roberts says. “I was getting praised for the behaviors that would’ve been red flags for someone of a different gender. What I have noticed is that it takes a whole lot for an eating disorder to get noticed in a man — that the behaviors have to be extremely, extremely interfering.”

Roberts says EDCE admitted its first male-identifying patient two years ago, but its residential center is not set up for them, meaning they cannot get live-in care. Some centers around the country have adapted to accommodate other genders, Roberts says. “My sense, however, is that most treatment centers and protocols, especially at the residential level, are still set up to serve female clients.”

EDCE has had to recalibrate goals for recovery, such as ideal body weight, as determined by measurements such as BMI (body mass index), to adjust for gender differences. Recent questionnaires have also sought to account for gender by addressing the diagnosis criteria.

Individuals of all gender identities — not just heterosexual females — have been shown to suffer from eating disorders. Studies estimate that as many as 30 million people in the United States have suffered from a clinically significant eating disorder in their lifetimes, with males comprising as much as one third. Exact numbers are hard to confirm, but Roberts says eating disorders in males are “underreported, without a doubt,” and suspects the actual number is higher. “There is a major need for therapists who can work with males,” he adds.

The National Alliance on Mental Illness (NAMI) website categorizes three types of criteria-based eating disorders: bulimia nervosa,anorexia nervosa and binge eating disorder. Muscle dysmorphia (“male anorexia,” “reverse anorexia” or “bigorexia”), characterized by an obsessive desire for muscularity, belongs to another category of disorder, but symptoms often overlap with eating disorders.EDNOS, or “eating disorder not otherwise specified,” is the catch-all diagnosis for people like Eric whose symptoms don’t fit exactly into one category.

Eating disorders center on obsessions with food, weight and body image, but how they manifest varies. NAMI’s website says, “Statistically, teenage girls and young women are more likely to have eating disorders, but they are more likely to be noticed/treated for one. Teenage boys and men are less likely seek help.”

By early 2015, Eric realized he needed help. The tug-of-war had become unbearable. He was attending classes at Lane Community College and living in a West Eugene house he shared with seven men. He spent most of his time in his room, leaving only to buy food and attend classes. He subsisted almost exclusively on trail mix, which he kept in bulk bags in his room.

Eric was miserable, going through seven to eight binge-purge cycles per day. He felt that if he didn’t get help, he would relapse to drinking and using drugs, which he’d struggled with in the past.

Getting Honest

Richers plans to return to school in the fall, and hopes to become a drug counselor or therapist. Photo Credit Andy Abeyta

Eric hit rock bottom. His misery and fear of relapse finally pushed him to “get honest.” One night in March, he confessed to his best friend and housemate, Kenji, who encouraged him to tell all the housemates.

Coming clean was a huge risk. Having a disorder, as a man, always caused Eric shame, guilt and embarrassment. But to his surprise and relief, his housemates were supportive and compassionate. One even connected him with a woman who was in treatment at EDCE. Just days after coming out, Eric checked himself in.

His six-day-a-week program at EDCE, part of a nationwide network of eating-disorder centers, includes sessions with therapist Roberts, check-ins with a nutritionist, weigh-ins, medical exams, group therapy, and “meal outings” to get re-oriented to the social dining experience. Eric says he had a customized meal plan to help him gain weight, but some days only adhered to it half the time.

Eric was confronted with the issue of gender in treatment. In group therapy, he would find himself reluctant to talk about matters related to body image and sex in a room full of women — literally, he felt like the odd man out.

One day, he says, his group watched a documentary called “America the Beautiful,” about societal pressures around female beauty. “Not once was it addressed how that affects and encourages eating disorders in men,” Eric says. “I don’t think it was [the filmmaker’s] intention to exclude men from the conversation, but I feel like I’ve been excluded, and that’s contributed so much to why it took so long for me to start talking about it, and compounds the amount of embarrassment and shame I feel around it.”

But in one-on-one therapy with Roberts, Eric has started to work through underlying issues.

Through education at EDCE, Eric realized just how dangerous his disorder could be. Roberts shared real cases. One stood out: a girl who died from cardiac arrest after only two years of purging.

“I was like, ‘holy shit, this is terrifying,'” Eric says of learning the health risks of his disorder. “My eating disorder is trying to kill me. If I continue on the path . . . I will die.”

On the surface, eating disorders may seem like a vanity thing, but they are mental illnesses that can be fatal. Robbing a body of vital nutrients over time can contribute to organ failure, dehydration, and more. The exact number of fatalities can’t be determined because compounding factors usually come into play; studies have definitively found links between eating disorders and other physical and mental illnesses. Substance abuse and suicide rank among the causes of death.

Since starting treatment, Eric has binged and purged a couple of times. He still restricts. But he now knows what’s at stake.

Eric continues to work towards recovery, but he’s realistic. Setbacks will happen. While some people recovering from addictions may be able to abstain, people recovering from eating disorders can’t simply not eat. Every day, at every meal, he has to face his triggers, and choose: listen to his healthy self, or let his disorder take over. In a way, he is relearning how to eat normally.

Treatment has helped Eric to understand his disorder and given him tools for recovery, but professionals differ on whether patients can be fully cured.

Eric is optimistic. He plans to go back to school in the fall. He hopes to become a drug counselor or therapist. At this moment, he’s sitting on his backyard deck thinking about his future. His bigger hope is to feel like his younger self again, the boy playing first base fifteen years ago, carefree and unconcerned. He still fears weight gain and struggles with body image. The battle isn’t won, but Healthy Eric is now armed.

“My disorder still occupies space, still holds a lot of power, for sure. But it’s not in that box anymore. I’m exposed. You know? For the first time I’m able to share what’s happening with me. God, what a relief.”

By UO School of Journalism and Communication Follow on Twitter Words By Hannah Golden. Photos by Andy Abeyta Courtesy of blog.oregonlive.com Feature Photo by Medical Center for Eating Disorders – We offer a Helping Hand sacredeatingdisorders.com

**Author’s Note: The information in this article was gathered over a period of four months, from a combination of in-person interviews, emails, texts, and professional and research sources.